Abstract 摘要
新冠病毒的全球大流行使全人類都深受其害，對人們的健康、財富以及福祉都帶來了巨大的影響。這就像一場世界大戰，但不同的是，我們都在同一條戰線上。全人類可以通力合作，瞭解這種疾病並開發工具與之鬥爭。我認為全球創新是減輕傷害的關鍵。這包括在檢測、治療、疫苗和政策上的創新，以遏制病毒的傳播並最大程度地減少對經濟和福祉的損害。
The coronavirus pandemic pits all of humanity against the virus. The damage to health, wealth, and well-being has already been enormous. This is like a world war, except in this case, we’re all on the same side. Everyone can work together to learn about the disease and develop tools to fight it. I see global innovation as the key to limiting the damage. This includes innovations in testing, treatments, vaccines, and policies to limit the spread while minimizing the damage to economies and well-being.
這份備忘錄分享了我對當前情況的看法，以及我們如何能夠加速這些創新。情況每天都在變化，有很多信息，其中許多都相互矛盾，而且你很難在諸多不同建議和想法中得出結論。聽起來我們似乎具備了重新開放經濟所需要的所有科學手段，但事實並非如此。儘管這篇文章裡的部分內容技術性很強，但我希望它能幫助人們理解正在發生的事情，明白我們仍然急需的創新，並就應對這種大流行病做出明智的決定。
This memo shares my view of the situation and how we can accelerate these innovations. (Because this post is long, it is also available as a PDF.) The situation changes every day, there is a lot of information available—much of it contradictory—and it can be hard to make sense of all the proposals and ideas you may hear about. It can also sound like we have all the scientific advances needed to re-open the economy, but in fact we do not. Although some of what’s below gets fairly technical, I hope it helps people make sense of what is happening, understand the innovations we still need, and make informed decisions about dealing with the pandemic.
Exponential growth and decline指數級增長和下降
In the first phase of the pandemic, we saw an exponential spread in a number of countries, starting with China and then throughout Asia, Europe, and the United States. The number of infections was doubling many times every month. If people’s behavior had not changed, then most of the population would have been infected. By changing behavior, many countries have gotten the infection rate to plateau and start to come down.
在大流行的第一階段，我們看到了它在許多國家呈指數級傳播，從中國開始，然後遍及亞洲、歐洲和美國。每個月的感染人數都在不斷翻倍。如果人們的行為沒有改變，那麼大多數人都會被感染。通過改變人們的行為，許多國家的感染率已趨於穩定並開始下降。
Exponential growth is not intuitive. If you say that 2 percent of the population is infected and this will double every eight days, most people won’t immediately figure out that in 40 days, the majority of the population will be infected. The big benefit of the behavior change is to reduce the infection rate dramatically so that, instead of doubling every eight days, it goes down every eight days.
指數增長並不是直觀的。如果說有2％的人口受到感染，並且感染人數每8天就會增加一倍，那麼大多數人不會立即明白——在40天內大多數人口都會被感染。行為改變的最大好處是可以大大降低感染率，因此，它不是每8天翻一倍，而是每8天都會顯著減少。
We use something called the reproduction rate, or R0 (pronounced “are-nought”), to calculate how many new infections are caused by an earlier infection. R0 is hard to measure, but we know it’s below 1.0 wherever the number of cases is going down and above 1.0 wherever the number of cases is going up. And what may appear to be a small difference in R0 can lead to very large changes.
我們使用基本傳染數R0來計算有多少新的感染是由先前的感染引起的。R0很難測量，但我們知道，當病例數下降時它小於1.0，當病例數上升時它大於1.0。R0的微小差異也會導致非常大的變化。
If every infection goes from causing 2.0 cases to only causing 0.7 infections, then after 40 days you have one-sixth as many infections instead of 32 times as many. That’s 192 times fewer cases. Here’s another way to think about it: If you started with 100 infections in a community, after 40 days you would end up with 17 infections at the lower R0 and 3,200 at the higher one. Experts are debating now just how long to keep R0 very low to drive down the number of cases before opening up begins.
如果每次感染從引發2個病例減少到引發0.7例，那麼40天后，感染的病例數將是原來的1/6，而不是32倍，也就是說減少了192倍的病例數。換一種方式思考：假設一個社區最開始有100個感染病例，40天后，在R0較低的情況下會有17個感染病例，而R0較高的情況下會有3200個感染病例。專家們正在辯論，在解禁前到底需要在多長時間內保持R0在很低水平才能拉低病例數。
Exponential decline is even less intuitive. A lot of people will be stunned that in many places we will go from hospitals being overloaded in April to having lots of empty beds in July. The whiplash will be confusing, but it is inevitable from the exponential nature of infection.
相比較而言，指數下降就更不直觀了。許多人都會驚訝的發現，很多地方的醫院4月份還超負荷運轉，而到了7月份就出現大量空床。突如其來的變化令人難以理解，但是從感染的指數性質來看，這是必然的。
As we get into the summer, some locations that maintain behavior change will experience exponential decline. However, as behavior goes back to normal, some locations will stutter along with persistent clusters of infections and some will go back into exponential growth. The picture will be more complex than it is today, with a lot of heterogeneity.
隨著夏天的到來，做到行為改變的一些地區將經歷指數級下降。但是，當人們的行為恢復正常時，一些地方會出現疫情反彈，而一些則將回到之前的指數級增長。未來的局面將比現在更加複雜並且差異化更大。
Have we overreacted? 我們反應過度了嗎？
It is reasonable for people to ask whether the behavior change was necessary. Overwhelmingly, the answer is yes. There might be a few areas where the number of cases would never have gotten large numbers of infections and deaths, but there was no way to know in advance which areas those would be. The change allowed us to avoid many millions of deaths and extreme overload of the hospitals, which would also have increased deaths from other causes.
人們有理由提出疑問，這種行為的改變是否有必要？很顯然，答案是肯定的。可能一些地區永遠不會出現大量的感染和死亡病例，但我們無法預知會是哪些地區。行為的改變可以讓我們避免數以百萬計的死亡和醫院的超負荷運轉，後者會導致因其他原因造成的死亡增加。
The economic cost that has been paid to reduce the infection rate is unprecedented. The drop in employment is faster than anything we have ever experienced. Entire sectors of the economy are shut down. It is important to realize that this is not just the result of government policies restricting activities. When people hear that an infectious disease is spreading widely, they change their behavior. There was never a choice to have the strong economy of 2019 in 2020.
為降低感染率所付出的經濟代價是史無前例的。就業率下降的速度超過我們以往的認知。許多行業都關停了。必須認識到這不僅僅是政府出臺相關隔離政策的結果。當人們聽說傳染病正在廣泛傳播時，他們自己就會改變行為。像2019年那樣強勁的經濟增長在2020年是不可能看到的。
Most people would have chosen not to go to work or restaurants or take trips, to avoid getting infected or infecting older people in their household. The government requirements made sure that enough people changed their behavior to get the reproduction rate below 1.0, which is necessary to then have the opportunity to resume some activities.
大多數人會選擇不去上班、不去餐館、不去旅遊，以避免自身感染或傳染家中的老年人。政府的要求確保了有足夠多的人改變了行為，以確保基本傳染數小於1.0，這樣將來才有機會恢復一些活動。
The wealthier countries are seeing reduced infections and starting to think about how to open up. Even as a government relaxes restrictions on behavior, not everyone will immediately resume the activities that are allowed. It will take a lot of good communication so that people understand what the risks are and feel comfortable going back to work or school. This will be a gradual process, with some people immediately doing everything that is allowed and others taking it more slowly. Some employers will take a number of months before they require workers to come back. Some people will want the restrictions lifted more rapidly and may choose to break the rules, which will put everyone at risk. Leaders should encourage compliance.
富裕國家的感染率正在下降並已經開始考慮如何解禁。即使政府放寬了對民眾行為的限制，也不意味著每個人都可以立即恢復生產生活。這需要很多良好的溝通，才能讓人們理解其中的風險，並安心重返工作或學校。這是一個循序漸進的過程，有些人會立即恢復正常生活，而另一些人可能會慢慢來。一些僱主可能會等幾個月的時間才要求員工回來工作。有些人會希望限制措施更快解除，並可能選擇違反規定，這將使所有人面臨風險。領導者應鼓勵大家遵守規則。
Differences among countries 國家之間的差異
The pandemic has not affected all countries equally. China was where the first infection took place. They were able to use stringent isolation and extensive testing to stop most of the spread. The wealthier countries, which have more people coming in from all over the world, were the next to be affected. The countries that reacted quickly to do lots of testing and isolation avoided large-scale infection. The benefits of early action also meant that these countries didn’t have to shut down their economies as much as others.
此次大流行對所有國家的影響並不相同。中國是最早發現感染的地方。他們能夠實施嚴格的隔離和廣泛的測試來阻止大面積傳播。第二波遭受影響的是那些比較富裕的國家，因為有來自世界各地的人會湧向那裡。那些反應迅速、進行大量測試並採取隔離措施的國家避免了大規模感染。儘早採取行動的好處還意味著這些國家不必像其他一些國家那樣令經濟停擺。
The ability to do testing well explains a lot of the variation. It is impossible to defeat an enemy we cannot see. So testing is critical to getting the disease under control and beginning to re-open the economy.
檢測能力的高低導致了許多差異化的存在。我們無法打敗看不見的敵人，檢測對控制疾病並重新啟動經濟至關重要。
So far, developing countries like India and Nigeria account for a small portion of the reported global infections. One of the priorities for our foundation has been to help ramp up the testing in these countries so they know their situation. With luck, some factors that we don’t understand yet, like how weather might affect the virus’s spread, will prevent large-scale infection in these countries.
到目前為止，印度和尼日利亞等發展中國家在已報告的全球感染病例中只佔很小一部分。蓋茨基金會的首要任務之一就是幫助提高這些國家的檢測水平，以便他們瞭解自己的狀況。幸運的話，我們尚不瞭解的一些因素，例如天氣或許會影響病毒的傳播，可能防止這些國家出現大規模感染。
However, our assumption should be that the disease dynamics are the same as in other countries. Even though their populations are disproportionately young—which would tend to mean fewer deaths from COVID-19—this advantage is almost certainly offset by the fact that many low-income people’s immune systems are weakened by conditions like malnutrition or HIV. And the less developed a country’s economy is, the harder it is to make the behavior changes that reduce the the virus's reproduction rate. If you live in an urban slum and do informal work to earn enough to feed your family every day, you won’t find it easy to avoid contact with other people. Also, the health systems in these countries have far less capacity, so even providing oxygen treatment to everyone who needs it will be difficult.
但是，我們的假設應該是，這種疾病的表現在每個國家都是一樣的。儘管他們的年輕人口比例特別高——這往往意味著死於新冠病毒的人數會更少——但幾乎可以肯定的是這一優勢會被抵消，因為營養不良或艾滋病病毒已經削弱了許多低收入人群的免疫系統。而且，一個國家的經濟越不發達，就越難做到行為的改變以降低病毒的基本傳染數。如果你生活在城市貧民區，每天做著非正式工作養家餬口，你會發現很難避免與他人接觸。此外，這些國家的衛生系統能力遠遠不足，所以即使向有需要的人提供氧氣治療也很困難。
Tragically, it is possible that the total deaths in developing countries will be far higher than in developed countries.
令人悲哀的是，發展中國家的死亡人數可能遠遠高於發達國家。
What we need to learn我們需要學習什麼
Our knowledge of the disease will help us with tools and policies. There are a number of key things we still don’t understand. A number of studies are being done to answer these questions, including one in Seattle done with the University of Washington. The global collaboration on these issues is impressive and we should know a lot more by the summer.
我們對疾病的瞭解將有助於我們開發工具和制定政策。有很多關鍵的事情我們仍然不明白，許多研究正在解答這些問題，其中就包括在西雅圖的華盛頓大學進行的一項研究。在這些問題上的全球合作令人欽佩，到今年夏天我們應該會看到很多突破。
- Is the disease seasonal or weather dependent? Almost all respiratory viruses (a group that includes COVID-19) are seasonal. This would mean there are fewer infections in the summer, which might lull us into complacency when the fall comes. This is a matter of degree. Because we see the novel coronavirus spreading in Australia and other places in the Southern hemisphere, where the seasons are the opposite of ours, we already know the virus is not as seasonal as influenza is.
- 這種疾病是季節性的還是氣候性的？ 幾乎所有的呼吸道病毒（包括冠狀病毒在內）都是季節性的。這意味著夏季感染病例會減少，而這可能會在秋季到來時使我們放鬆警惕。但這種季節性有個程度問題。因為我們看到新冠病毒正在澳大利亞和南半球的其他地方傳播，而那裡的季節與我們的相反，所以我們知道這種病毒不像流感那麼具有季節性。
- How many people who never get symptoms have enough of the virus to infect others? What about people who are recovered and have some residual virus—how infectious are they? Computer models show that if there are a lot of people who are asymptomatic but infectious, it is much harder to open up without a resurgence in cases. There is a lot of disagreement about how much infection comes from these sources, but we do know that many people with the virus don’t report symptoms, and some portion of those might end up transmitting it.
- 有多少無症狀感染者攜帶了足以感染他人的病毒？那些康復後還帶有殘留病毒的人，他們的傳染性有多強？計算機模型顯示，如果有很多人無症狀卻具備傳染性，一旦解禁就很可能讓疫情捲土重來。關於有多少感染來自這些無症狀感染者有很多分歧，但我們知道很多人感染病毒後沒有症狀，而其中一些人最終傳播了病毒。
- Why do young people have a lower risk of becoming seriously ill when they get infected? Understanding the dynamics here will help us weigh the risks of opening schools. It is a complicated subject because even if young people don’t get sick as often, they might still spread the disease to others.
- 為什麼年輕人感染後重症的風險比較低？ 瞭解這種動態將有助於我們評估開學的風險。這是一個複雜的問題，因為即使年輕人不經常發病，他們仍可能將疾病傳播給其他人。
- What symptoms indicate you should get tested? Some countries are taking the temperature of lots of people as an initial screening tool. If doing this helps us find more potential cases, we could use it at airports and large gatherings. We need to target the tests we have at the people at greatest risk since we don’t have enough tests for everyone.
- 出現什麼症狀表明你應該接受檢測？一些國家把對大眾的體溫檢測作為初步篩查的工具。如果這種方法有助於我們發現更多的潛在病例，我們可以在機場和大型集會上廣泛使用它。我們需要針對高風險人群進行檢測，因為我們沒有足夠的資源檢測每個人。
- Which activities cause the most risk of infection? People ask me questions about avoiding prepared food or door knobs or public toilets so they can minimize their risk. I wish I knew what to tell them. Judgements will have to be made about different kinds of gatherings like classes or church going and whether some kind of spacing should be required. In places without good sanitation, there may be spread from fecal contamination since people who are infected shed the virus.
- 從事哪些活動導致感染的風險最大？人們會問我避免點外賣、碰觸門把手或使用公共廁所是否可以最大程度地降低風險。我也希望我有答案。人們需要對不同類型的聚集進行判斷，例如上課或參加教堂聚會，是否需要保持距離。在衛生條件不好的地方，病毒也會通過被感染者的糞便傳播。
- Who is most susceptible to the disease? We know that older people are at much greater risk of both severe illness and death. Understanding how gender, race, and co-morbidities affect this is a work in progress.
- 誰最容易感染這種疾病？ 我們知道，老年人重症和死亡的風險要大得多。而針對性別、種族和併發症的影響的研究工作還在進行中。
The Gates Foundation’s role蓋茨基金會的角色
In normal times, the Gates Foundation puts more than half of its resources into reducing deaths from infectious diseases. These diseases are the reason why a child in a poor country is 20 times more likely to die before the age of five than one in a rich country. We invest in inventing new treatments and vaccines for these diseases and making sure they get delivered to everyone who needs them. The diseases include HIV, malaria, tuberculosis, polio, and pneumonia. Whenever there is an epidemic like Ebola, SARS, or Zika we work with governments and the private sector to help model the risks and to help galvanize resources to create new tools to stop the epidemic. It was because of these experiences that I spoke out about the world not being ready for a respiratory epidemic in my 2015 TED talk. Although not enough was done, a few steps were taken to prepare, including the creation of the Coalition for Epidemic Preparedness Innovation, which I will discuss below, in the vaccine section.
通常情況下，蓋茨基金會將其一半以上的資源用於減少傳染病造成的死亡。這些疾病正是導致貧窮國家5歲以下兒童死亡率比發達國家高20倍的原因。我們投資研發針對這些疾病的新療法和疫苗，並努力確保將它們提供給每一個有需要的人。這些疾病包括艾滋病、瘧疾、結核病、脊髓灰質炎和肺炎。每當像埃博拉、非典型肺炎或寨卡這樣的大流行病出現時，我們都會與政府和私營部門合作，幫助建立風險模型並調動資源開發新的工具來遏制疫情。正是基於這些經驗，我在2015年的TED演講中公開表示，世界還沒有做好應對呼吸道傳染病的準備。儘管做得還不夠，但有一些準備工作還是啟動了，包括建立流行病防範創新聯盟（Coalition for Epidemic Preparedness Innovation，CEPI），我將在下面有關疫苗的部分對此進行討論。
Now that the epidemic has hit, we are applying our expertise to finding the best ideas in each area and making sure they move ahead at full speed. There are many efforts going on. More than 100 groups are doing work on treatments and another 100 on vaccines. We are funding a subset of these but tracking all of them closely. It is key to look at each project to see not only its chance of working but also the odds that it can be scaled up to help the entire world.
疫情暴發後，我們正在運用所有的專業知識，在每個領域中尋找最好的想法，並確保它們得到全速推進。很多工作都在進行中，有超過100個團隊正在研發新的治療方法，而另外100個團隊正在攻關疫苗。我們資助了其中一部分，但對所有項目的進展都密切關注。每個項目的關鍵不僅在於其成功的可能性，還要看它能否實現規模化來幫助整個世界。
One urgent activity is to raise money for developing new tools. I think of this as the billions we need to spend so we can save trillions. Every additional month that it takes to get the vaccine is a month when the economy cannot return to normal. However, it isn’t clear how countries will come together to coordinate the funding. Some could go directly to the private sector but demand that their citizens get priority. There is a lot of discussion among governments, the World Health Organization, the private sector, and our foundation about how to organize these efforts.
眼下極為緊迫的是為研發新工具籌集資金。我認為在這方面投資數十億美元可以幫助我們最終節省數萬億美元。距離最終用上疫苗的時間每增加一個月，經濟就會晚一個月恢復正常。但是，尚不清楚各國將如何合作來協調資金。有些國家可以直接尋求私營部門的幫助，但會要求其公民享有優先權。各國政府、世界衛生組織、私營部門和蓋茨基金會就如何協調各方的努力進行了很多探討。
Innovation to beat the enemy用創新戰勝敵人
During World War II, an amazing amount of innovation, including radar, reliable torpedoes, and code-breaking, helped end the war faster. This will be the same with the pandemic. I break the innovation into five categories: treatments, vaccines, testing, contact tracing, and policies for opening up.Without some advances in each of these areas, we cannot return to the business as usual or stop the virus. Below, I go through each area in some detail.
第二次世界大戰期間，包括雷達、魚雷和破譯密碼在內的大量創新使戰爭得以更快地結束。大流行病也將如此。我將創新分為五個領域：治療方法、疫苗、檢測、接觸者追蹤和復工復產政策。如果在這些領域不能取得特定進展，我們將無法恢復正常或阻止病毒傳播。下面，我將就每個領域做詳細介紹。
Treatments 治療方法
Every week, you will be reading about new treatment ideas that are being tried out, but most of them will fail. Still, I am optimistic that some of these treatments will meaningfully reduce the disease burden. Some will be easier to deliver in rich countries than developing countries, and some will take time to scale. A number of these could be available by the summer or fall.
每週你都會了解到一些新的治療方法正在進行測試，但絕大多數都會失敗。儘管如此，我仍樂觀地認為，其中一些治療方法將能夠真正地減輕疾病負擔。有些方法在發達國家要比在發展中國家更容易開展，還有一些則需要更多的時間才能擴大規模。很多療法要到夏天或秋天才可能落地實施。
If in the spring of 2021 people are going to big public events—like a game or concert in a stadium—it will be because we have a miraculous treatment that made people feel confident about going out again. It’s hard to know precisely what the threshold is, but I suspect it is something like 95 percent; that is, we need a treatment that is 95 percent effective in order for people to feel safe in big public gatherings. Although it is possible that a combination of treatments will have over 95 percent effectiveness, it’s not likely, so we can’t count on it. If our best treatments reduce the deaths by less than 95 percent, then we will still need a vaccine before we can go back to normal.
如果在2021年的春天，人們紛紛去參加大型的公共活動，比如在體育場舉辦的比賽或演唱會，那將會是因為我們有了一個奇蹟般的療法，讓人們有了再次出門的信心。目前很難給出精確的標準，我猜測是95%左右，也就是說，我們需要一種有效率達到95%的療法，這樣人們才能有足夠的安全感去參與大型公開活動。儘管某種聯合療法可能達到95%以上的有效性，但這僅僅是種可能性，我們無法指望它。如果我們最好的治療方法也不能將死亡降低95%的話，我們仍需要疫苗才能恢復正常生活。
One potential treatment that doesn’t fit the normal definition of a drug involves collecting blood from patients who have recovered from COVID-19, making sure it’s free of the coronavirus and other infections, and giving the plasma to people who are sick. The leading companies in this area are working together to get a standard protocol to see if this works. They will have to measure each patient to see how strong their antibodies are. A variant of this approach is to take the plasma and concentrate it into a compound called hyperimmune globulin, which is much easier and faster to give a patient than unconcentrated plasma. The foundation is supporting a consortium of most of the leading companies that work in this area to accelerate the evaluation and, if the procedure works, be ready to scale it up. These companies have developed a Plasma Bot to help recovered COVID-19 patients donate plasma for this effort.
有一種不符合常規藥物定義的潛在療法是從新冠肺炎康復者身上採集血液，確保它沒有冠狀病毒和其他感染，然後將血漿提供給其他病人。這個領域的領先公司正在共同努力制定一個標準化方案，以檢驗血漿療法是否有效。他們必須檢測每個病人的血液來確認抗體的強度。這種方法的一個變體是將血漿濃縮成一種稱為超免疫球蛋白的化合物，可以比未經處理的血漿更容易也更快地提供給病人。蓋茨基金會正在支持許多這一領域的領先企業加速評估進程，並在該方案證明有效的情況下做好規模化的準備。這些公司開發了血漿機器人程序（Plasma Bot）幫助已康復患者為這一治療方案捐獻血漿。
Another type of potential treatment involves identifying the antibodies produced by the human immune system that are most effective against the novel coronavirus. Once those antibodies have been found, they can be manufactured and used as a treatment or as a way to prevent the disease (in which case it is known as passive immunization). This antibody approach also has a good chance of working, although it’s unclear how many doses can be made. It depends on how much antibody material is needed per dose; in 2021, manufacturers may be able to make as few as 100,000 treatments or many millions. The lead times for manufacturing are about seven months in the best case. Our grantees are working to compare the different antibodies and make sure the best ones get access to the limited manufacturing capacity.
另一種可能的療法是發現人體免疫系統所產生的抗體，這些抗體對新冠病毒是最為有效的。一旦我們找到這些抗體，就可以製造它們並用於治療或作為預防疾病的方法（通常被稱為“被動免疫”）。這種抗體療法也很有可能起作用，雖然還不確定我們能夠生產多少劑量，這取決於每一劑需要多少抗體。到2021年，我們可能能夠生產出10萬甚至數百萬製劑。最好的情況下生產製劑的準備時間在7個月左右。我們資助的夥伴正在比較不同的抗體，以確保那些最好的能在產能有限的情況下被優先生產。
There is a class of drugs called antivirals, which keep the virus from functioning or reproducing. The drug industry has created amazing antivirals to help people with HIV, although it took decades to build up the large library of very effective triple drug therapies. For the novel coronavirus, the leading drug candidate in this category is Remdesivir from Gilead, which is in trials now. It was created for Ebola. If it proves to have benefits, then the manufacturing will have to be scaled up dramatically.
有一類藥物被稱作“抗病毒藥物”，可以阻止病毒的作用或繁殖。製藥行業已經制造出神奇的抗病毒藥物來幫助艾滋病病毒攜帶者，儘管建立一個有效的三聯藥物療法的龐大數據庫用了幾十年的時間。對於新冠病毒，這一類別的領先候選藥物是來自吉利德公司的瑞德西韋，它目前正在臨床試驗中。瑞德西韋本是為應對埃博拉病毒而研發成功的，如果證明對新冠肺炎有效，那麼則需要大幅擴大生產規模。
The foundation recently asked drug companies to provide access to their pipeline of developed antiviral drugs so researchers funded by the Therapeutics Accelerator can run a screen to see which should go into human trials first. The drug companies all responded very quickly, so there is a long list of antivirals being screened.
蓋茨基金會最近要求製藥公司開放他們正在開發的抗病毒藥物管線，以便那些得到“（新冠肺炎）治療加速器”（Therapeutics Accelerator）資助的研究人員能夠篩選可率先進行人體試驗的藥物。這些製藥公司都很快做出了回應，因此目前有一長串有待篩選的抗病毒藥物。
Another class of drugs works by changing how the human body reacts to the virus. Hydroxychloroquine is in this group. The foundation is funding a trial that will give an indication of whether it works on COVID-19 by the end of May. It appears the benefits will be modest at best. Another type of drug that changes the way a human reacts to a virus is called an immune system modulator. These drugs would be most helpful for late-stage serious disease. All of the companies that work in this area are doing everything they can to help with trials.
另一類藥物的工作原理是改變人體對病毒的反應方式。羥氯喹就屬於這類藥物。蓋茨基金會正在資助一項試驗，將在5月底之前證明它是否對新冠病毒有效。目前來看，它的療效不大。另一種改變人類對病毒反應的藥物被稱為免疫系統調節劑，這些藥物對嚴重的晚期重症最有療效，該領域的所有公司都正在傾其所能進行試驗。
Vaccines 疫苗
Vaccines have saved more lives than any other tool in history. Smallpox, which used to kill millions of people every year, was eradicated with a vaccine. New vaccines have played a key role in reducing childhood deaths from 10 million per year in 2000 to fewer than 5 million per year today.
疫苗挽救的生命比歷史上任何其他工具都多。曾經造成每年數百萬人死亡的天花，通過疫苗被根除。新開發的疫苗在減少兒童死亡人數方面發揮了關鍵作用，使兒童死亡人數從2000年的每年1000萬減少到今天的每年不到500萬。
Short of a miracle treatment, which we can't count on, the only way to return the world to where it was before COVID-19 showed up is a highly effective vaccine that prevents the disease.
我們不能只寄希望於奇蹟般的治療方法。要想讓世界恢復到新冠肺炎出現之前的狀態，唯一的辦法就是用高效的疫苗來預防這種疾病。
Unfortunately, the typical development time for a vaccine against a new disease is over five years. This is broken down into: a) making the candidate vaccine; b) testing it in animals; c) safety testing in small numbers of people (this is known as phase 1); d) safety and efficacy testing in medium numbers (phase 2); e) safety and efficacy testing in large numbers (phase 3); and f) final regulatory approval and building manufacturing while registering the vaccine in every country.
遺憾的是，一種新疾病的疫苗開發通常需要5年以上。這個流程可以被細分為：a)製造候選疫苗；b)動物試驗；c) 對小規模人群進行安全試驗（1期臨床試驗）；d) 對中等規模人群進行安全和有效性試驗（2期臨床試驗）; e)對大規模人群的安全和有效性試驗（3期臨床試驗）；f)在每個國家進行疫苗註冊時同步進行最終監管審批和生產製造準備。
Researchers can save time by compressing the clinical safety/efficacy phases while conducting animal tests and building manufacturing capacity in parallel. Even so, no one knows in advance which vaccine approach will work, so a number of them need to be funded so they can advance at full speed. Many of the vaccine approaches will fail because they won’t generate a strong enough immune response to provide protection. Scientists will get a sense of this within three months of testing a given vaccine in humans by looking at the antibody generation. Of particular interest is whether the vaccine will protect older people, whose immune systems don’t respond as well to vaccines.
通過在做臨床安全及有效性試驗的同時，平行開展動物試驗以及產能建設，研究人員可以從中節省一些時間。即便如此，沒有人能提前知道哪種疫苗會有效，所以我們需要資助若干疫苗開發，以便它們都能夠全速推進。許多疫苗最終都會失敗，因為它們無法產生足夠強大的免疫反應保護人體。通過觀察抗體的產生，我們預計將在三個月內從人體測試中得到答案。特別值得關注的是，疫苗是否能夠保護老年人，因為他們的免疫系統對疫苗的反應並不是很理想。
The issue of safety is obviously very important. Regulators are very stringent about safety, to avoid side effects and also to protect the reputation of vaccines broadly, since if one has significant problems, people will become more hesitant to take any vaccines. Regulators worldwide will have to work together to decide how large the safety database needs to be to approve a COVID-19 vaccine.
安全問題顯然是非常重要的。監管機構對於疫苗的安全性要求非常嚴格，一方面是為了避免副作用，另一方面也是為了廣泛地保護疫苗的聲譽。如果一個疫苗出現重大問題，人們就會因此對任何免疫接種猶豫不決。世界各地的監管機構將需要共同努力以決定需要多少安全性數據才能批准新冠肺炎疫苗。
One step that was taken after the foundation and others called for investments in pandemic preparedness in 2015 was the creation of the Coalition for Epidemic Preparedness Innovations (CEPI). Although the resources were quite modest, they have helped advance new approaches to making vaccines that could be used for this pandemic. CEPI added resources to work on an approach called RNA vaccines, which our foundation had been supporting for some time. Three companies are pursuing this approach. The first vaccine to start human trials is an RNA vaccine from Moderna, which started a phase 1 clinical safety evaluation in March.
蓋茨基金會和其他組織在2015年共同呼籲對大流行病防範工作進行投資，並隨後創建了流行病預防創新聯盟。雖然資源相當有限，但該聯盟幫助推進了新方法，可以用於這一次大流行病的疫苗開發。CEPI正在加大投入研究RNA疫苗，這種方法一直獲得蓋茨基金會的支持。現在，有三家公司正在採用這種疫苗開發手段。第一個開始人體試驗的疫苗是來自Moderna的RNA疫苗，該疫苗於3月份開始了1期臨床安全性評估。
An RNA vaccine is significantly different from a conventional vaccine. A flu shot, for example, contains bits of the flu virus that your body’s immune system learns to attack. This is what gives you immunity. With an RNA vaccine, rather than injecting fragments of the virus, you give the body the genetic code needed to produce lots of copies of these fragments. When the immune system sees the viral fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit.
RNA疫苗與傳統疫苗有顯著差異。例如，流感疫苗中含有少量流感病毒，而人體的免疫系統會學會攻擊這些病毒，這就是人體獲得免疫的方法。RNA疫苗並非注射病毒片段，而是給身體提供產生大量病毒片段副本所需的遺傳密碼。當免疫系統看到這些病毒片段，它會學習如何攻擊它們。RNA疫苗本質上就是把人體變成自己的疫苗生產部門。
There are also at least five leading efforts that look promising and that use other approaches to teach the immune system to recognize and attack a viral infection. CEPI and our foundation will be tracking efforts from all over the world to make sure the most promising ones get resources. Once a vaccine is ready, our partner GAVI will make sure it is available even in low-income countries.
現在還有至少5種項目看起來很有希望，它們使用其他方法來“教會”免疫系統識別和攻擊病毒感染。CEPI 和蓋茨基金會將繼續跟蹤世界各地的項目，以確保最有前景的疫苗能獲得資源。一旦疫苗準備就緒，我們的合作伙伴全球疫苗免疫聯盟（Gavi）將確保低收入國家也能獲得疫苗。
A big challenge for vaccine trials is that the time required for the trials depends on finding trial locations where the rate of infection is fairly high. While you are setting up the trial site and getting regulatory approval, the infection rate in that location could go down. And trials have to involve a surprisingly large number of people. For example, suppose the expected rate of infection is 1 percent per year and you want to run a trial where you would expect 50 people to be infected without the vaccine. To get a result in six months the trial would need 10,000 people in it.
疫苗試驗的一大挑戰是，試驗所需的時間取決於找到高感染率的試驗地點。而在設置試驗站點並尋求監管機構批准的過程中，該地的感染率可能已經下降，而試驗需要大量的人參與。舉例來說，假設預期的感染率是每年1%，那你要開展的試驗就預期有50人在沒有接種疫苗的情況下被感染。那麼，為了在6個月內得到結果，這個試驗就需要10,000人參與。
The goal is to pick the one or two best vaccine constructs and vaccinate the entire world—that’s 7 billion doses if it is a single-dose vaccine, and 14 billion if it is a two-dose vaccine. The world will be in a rush to get them, so the scale of the manufacturing will be unprecedented and will probably have to involve multiple companies.
我們的目標是選擇一到兩種最好的疫苗，併為全世界人口進行疫苗接種——如果是單劑疫苗，那麼就需要70億劑；如果是兩劑疫苗，則為140億劑。全世界都將爭相獲得這些疫苗，因此生產疫苗的規模將是前所未有的，很可能需要多家公司參與。
I am often asked when large-scale vaccination will start. Like American’s top public health officials, I say that it is likely to be 18 months, even though it could be as short as nine months or closer to two years. A key piece will be the length of the phase 3 trial, which is where the full safety and efficacy are determined.
我常被問及大規模疫苗接種何時可以開始。和美國權威的公共衛生官員們的估計一樣，我認為可能需要18個月，儘管也可能短至9個月或長至近2年。關鍵在於3期試驗的時長，這將充分確保安全性和有效性。
When the vaccine is first being manufactured, there will be a question of who should be vaccinated first. Ideally, there would be global agreement about who should get the vaccine first, but given how many competing interests there are, this is unlikely to happen. The governments that provide the funding, the countries where the trials are run, and the places where the pandemic is the worst will all make a case that they should get priority.
當首批疫苗被產出時，將會出現一個問題：誰應該優先接種疫苗。理想情況下，全球應該就此達成共識。但鑑於存在太多相互競爭的利益關係，這種共識不太可能發生。那些提供資金的政府、進行臨床試驗的國家，以及疫情最嚴重的地方，都會提出他們應該得到優先接種的理由。
Testing 檢測
All of the tests to date for the novel coronavirus involve taking a nasal swab and processing it in a Polymerase Chain Reaction (PCR) machine. Our foundation invested in research showing that having patients do the swab themselves, at the tip of the nose, is as accurate as having a doctor push the swab further down to the back of your throat. Our grantees are also working to design swabs that are cheap and able to be manufactured at large scale but work as well as ones that are in short supply. This self-swab approach is faster, protects health care workers from the risk of exposure, and should let regulators approve swabbing in virtually any location instead of only at a medical center. The PCR test is quite sensitive—it will generally show whether you have the virus even before you have symptoms or are infecting other people.
迄今為止，對新冠病毒的所有檢測都包括鼻拭子採樣並用聚合酶鏈式反應分析儀（PCR儀）對樣本進行處理分析。蓋茨基金會投資的一項研究證明了讓患者自己在鼻腔前端採樣，與醫生將拭子一直深入咽喉採樣一樣準確。我們資助的夥伴也正在努力研發低價且能大規模生產的拭子，這種新型拭子會和那些供貨不足的拭子一樣好用。這種自查工具更加快捷，也避免了醫護人員每次檢測前都需要更換防護裝備，監管機構應該批准在家自測，不用都去醫療中心。PCR檢測非常靈敏——它通常會在患者出現症狀或感染其他人之前就顯示你已經感染了病毒。
There has been a lot of focus on the number of tests being performed in each country. Some, like South Korea, did a great job of ramping up the testing capacity. But the number of tests alone doesn’t show whether they are being used effectively. You also have to make sure you are prioritizing the testing on the right people. For example, health care workers should be able to get an immediate indication of whether they are infected so they know whether to keep working. People without symptoms should not be tested until we have enough tests for everyone with symptoms. Additionally, the results from the test should come back in less than 24 hours so you quickly know whether to continue isolating yourself and quarantining the people who live with you. In the United States, it was taking over seven days in some locations to get test results, which reduces their value dramatically. This kind of delay is unacceptable.
每個國家的檢測數量一直是人們關注的焦點。一些國家，比如韓國，在提高檢測能力方面做得非常好。但是，單看檢測數量本身並不能說明它們得到了有效使用，還必須確保優先對適當人群進行檢測。例如，醫務工作者應該可以立即得到檢測結果來確定他們是否能夠繼續工作。而在我們有足夠的能力為每個有症狀的人提供檢測之前不該檢測那些未出現症狀的人。此外，檢測結果應該在24小時內出來，這樣就可以儘快知道你是否要繼續隔離自己和那些與你住在一起的人。美國有些地方需要7天以上才能得到檢測結果，這大大降低了檢測的價值，這樣的滯後是不能接受的。
There are two types of PCR machines: high-volume batch processing machines and low-volume machines. Both have a role to play. The high-volume machines provide most of the capacity. The low volume machines are better when getting a result in less than an hour is beneficial. Everyone who makes these machines, and some new entrants, are making as many machines as they can. Adding this capacity and making full use of the machines that are already available will increase the testing capacity. The foundation is talking to the manufacturers about different ways to run the big machines that could make them more than twice as productive.
PCR儀有兩種類型：大批量處理機和小批量處理機，兩種都有各自適用的場景。大批量處理機提供了大量的檢測能力，小批量處理機有利於在一個小時內得到檢測結果。原有的以及新加入的PCR儀器製造商都在竭盡所能地生產。加大產能並充分利用已有的儀器將會增加檢測能力。蓋茨基金會也正在與製造商討論如何以不同的方法運行這些大機器從而讓它們的效率提高一倍以上。
Another type of test being developed is called a Rapid Diagnostic Test (RDT). This would be like an in-home pregnancy test. You would swab your nose the same way as for the PCR test, but instead of sending it into a processing center, you would put it in a liquid container and then pour that liquid onto a strip of paper that would change color if it detects the virus. This form of test may be available in a few months. Even though it won’t be as sensitive as a PCR test, for someone who has symptoms it should be quite accurate. You would still need to report your test result to your government since they need visibility into the disease trends.
另一種正在開發的檢測方法叫做快速診斷檢測（Rapid Diagnostic Test, RDT）。這種檢測就像家用驗孕棒一樣。你可以用PCR檢測的方法進行鼻拭子採樣，但不用送到檢測中心，只要把樣本放入容器中，再把液體倒在試紙上。如果檢測到病毒，試紙就會變色。這種快速檢測可能在幾個月後就可以使用了。儘管可能不如PCR檢測一般靈敏，但對於那些已經出現症狀的人來說，這種檢測方法還是相當準確的。你仍然需要向當地政府報告檢測結果，因為他們仍需要藉此瞭解疾病發展趨勢。
A lot of people talk about the serology test, where you give blood and it detects whether you have antibodies against the virus. If you do, it means you have been exposed. These tests only show positive results late in your disease, so they do not help you decide whether to quarantine. Also, all the tests done so far have problems with false positives. Until we understand what level of antibodies is protective and have a test with almost no false positives, it is a mistake to tell people not to worry about their exposure to infection based on the serology tests that are available today. In the meantime, serology tests will be used to see who can donate blood and to understand the disease dynamics.
許多人也在談論血清檢測，這種檢測方法是利用血液樣本來檢測人體是否含有對抗病毒的抗體。如果含有抗體，這就意味著你已經暴露於病毒了。然而，這種檢測方法只能在疾病後期才能檢測出陽性，所以無法幫助人們決定是否要自主隔離。此外，到目前為止所有檢測方法都存在有假陽性的問題。除非我們已經瞭解什麼水平的抗體才是具有保護性的，並且研發出一個幾乎沒有假陽性的檢測方法，否則基於現有的血清檢測就告訴人們不要擔心感染是錯誤的。與此同時，血清檢測將被用來了解誰可以獻血及疾病動態。
A lot of countries did a good job focusing the PCR capacity on the priority patients. Most countries had their government play a central role in this process. In the United States, there is no system for making sure the testing is allocated rationally. Some states have stepped in, but even in the best states, the access isn’t fully controlled.
許多國家在集中PCR檢測能力用於緊急患者方面做得很好。大多數國家的政府在這一進程中都發揮著核心作用。美國目前還沒有一套可以確保檢測能力合理分配的制度。一些州政府已經介入，但即使在做的最好的州，也沒有完全掌控檢測能力的分配。
Testing becomes extremely important as a country considers opening up. You want to have so much testing going on that you see hot spots and are able to intervene by changing policy before the numbers get large. You don’t want to wait until the hospitals start to fill up and the number of deaths goes up.
當一國考慮開放邊境時，檢測將變得極其重要。你會希望檢測越多越好，以便看到發病熱點區域，並且能夠在數據激增之前通過改變政策進行干預。你不希望等到醫院人滿為患、死亡人數上升時才開始注重檢測。
Basically, there are two critical cases: anyone who is symptomatic, and anyone who has been in contact with someone who tested positive. Ideally both groups would be sent a test they can do at home without going into a medical center. Tests would still be available in medical centers, but the simplest is to have the majority done at home. To make this work, a government would have to have a website that you go to and enter your circumstances, including your symptoms. You would get a priority ranking, and all of the test providers would be required to make sure they are providing quick results to the highest priority levels. Depending on how accurately symptoms predict infections, how many people test positive, and how many contacts a person typically has, you can figure out how much capacity is needed to handle these critical cases. For now, most countries will use all of their testing capacity for these cases.
基本上有兩種情況應該接受檢測，一種是有症狀的人，另一種是任何與檢測呈陽性病例有過接觸的人。理想情況是，上述的兩類人員都可以在家檢測，而無需前往醫療中心。你仍然可以在醫療中心進行檢測，但最簡單的方法是讓大多數人在家裡完成檢測。要實現這一點，政府必須建立一個網站，供人們訪問並提交包括症狀在內的相關情況。你會就此得到一個優先級排序，最後應確保所有檢測中心可以根據優先級提供快速的檢測結果。根據由症狀預測感染的準確程度、檢測出陽性的人數，以及一個人通常有多少接觸者，你可以計算出處理這些病例所需要的資源。目前，絕大多數的國家都將使用其所有的檢測能力來應對新冠病例。
There will be a temptation for companies to buy testing machines for their employees or customers. A hotel or cruise ship operator would like to be able to test everyone even if they don’t have symptoms. They will want to get PCR machines that give quick results or the rapid diagnostic test. These companies will be able to bid very high prices—well above what the public health system would bid—so governments will have to determine when there is enough capacity to allow this.
企業將傾向於為員工或客戶購買檢測設備。酒店或遊輪運營商也希望能夠檢測每個客人，即使他們沒有症狀。他們希望獲得PCR儀或快速診斷檢測工具以儘快獲得檢測結果，而這些公司出價很高——遠高於公共衛生系統——因此政府必須確定何時才有足夠的檢測能力可以允許這樣的情況發生。
One assumption is that people who need to get tested will isolate themselves and quarantine those in their household. Some governments police this carefully, whereas others simply assume people will follow the recommendation. Another issue is whether a government provides a place for someone to isolate themselves if they can’t do it at their home. This is particularly important if you have older people in close quarters at your house.
一種假設是，需要接受檢測的人都會把自己和家人隔離起來。有些政府對此進行嚴格的監管，而有些政府則簡單地設想人們會自發遵循隔離建議。另一個問題是，如果不能在家隔離，政府是否能夠提供隔離的場所。當家裡有老人時，這一點尤其重要。
Contact tracing 接觸者追蹤
I mentioned in the testing section that one of the key priorities for testing is anyone who has been in close contact with someone who has tested positive. If you can get a list of these people quickly and make sure they are prioritized for a test like the PCR test (which is sensitive enough to detect a recent infection), then these people can isolate themselves before they infect other people. This is the ideal way of stopping the spread of the virus.
我在檢測部分提到，為測試結果呈陽性患者的密切接觸者提供檢測是工作重點之一。如果你能夠迅速拿到這些人的名單，確保他們可以優先進行PCR檢測 （這些檢測足夠靈敏可以甄別出近期感染患者），那麼在傳染其他人之前，這些人就能夠進行自我隔離。這是阻斷病毒傳播的理想方式。
Some countries, including China and South Korea, required patients to turn over information about where they have been in the last 14 days by looking at GPS information on their phone or their spending records. It is unlikely that Western countries will require this. There are applications you can download that will help you remember where you have been; if you ever test positive, then you can voluntarily review the history or choose to share it with whoever interviews you about your contacts.
包括中國、韓國在內的一些國家要求患者通過手機GPS信息或消費記錄，來提供他們過去14天行蹤信息。而在另外一些國家，你可以通過下載一些應用程序來幫助你回憶之前去過的地方。如果你的檢測結果呈陽性，你可以自主查看相關歷史記錄，或選擇分享給前來詢問你過去接觸史的人。
A number of digital approaches are being proposed where phones detect what other phones are near them. (It would involve using Bluetooth plus sending a sound out that humans can’t hear but that verifies that the two phones are reasonably close to each other.) The idea is that if someone tests positive then their phone can send a message to the other phones and their owners can get tested. If most people voluntarily installed this kind of application, it would probably help some. One limitation is that you don’t necessarily have to be in the same place at the same time to infect someone—you can leave the virus behind on a surface. This system would miss this kind of transmission.
很多諸如讓手機探測周圍手機的數字解決方案正在被提出來（這將涉及到使用藍牙，以及發送一個人耳無法聽到的聲音，來驗證兩部手機是否離得很近）。這個方法是如果有人檢測結果呈陽性，那他的手機可以給其他手機發送信息，讓這些手機的持有者也進行檢測。如果大多數人都自願安裝這樣的應用程序，這或許能夠有些幫助。一個不足之處在於，你不一定要通過直接接觸感染他人——你可能會將病毒留在物體表面，而這一方法會遺漏這種傳播方式。
I think most countries will use the approach that Germany is using, which requires interviewing everyone who tests positive and using a database to make sure there is follow-up with all the contacts. The pattern of infections is studied to see where the risk is highest and policy might need to change.
我認為很多國家將採取德國的方式，他們會詢問每一個檢測結果呈陽性的患者，並使用數據庫來確保對所有接觸者都進行追蹤。通過研究感染的模式，來了解哪裡風險最高，哪些政策可能需要改變。
In Germany, if someone is tested and confirmed positive, the doctor is legally required to inform the local government health office. The doctor must provide all personal data—name, address, phone number—so that the health office can contact the person and ensure they isolate themselves.
在德國，如果有人檢測結果確認為陽性，醫生必須依法通知當地衛生部門。醫生必須提供患者的個人信息，包括姓名、地址、手機號碼等，以便衛生部門能夠聯繫到此人，並確保他們進行自我隔離。
Then the local health office begins the process of contact tracing. They interview the infected person, find out how to contact all the people he or she has met in the past couple of weeks, and contact those people to ask them to self-isolate and get a test.
隨後，當地衛生部門開始進行接觸者追蹤。他們會與感染者溝通，找出他們過去幾周的接觸者，聯繫這些人並讓他們進行自我隔離與檢測。
This approach relies on the infected person to report their contacts accurately, and also depends on the ability of the health authorities to follow up with everyone. The normal health service staff can’t possibly do all this work even if the case numbers are fairly low. Every health system will have to figure out how to staff up so that this work is done in a timely fashion. Everyone who does the work would have to be properly trained and required to keep all the information private. Researchers would be asked to study the database to find patterns of infection, again with privacy safeguards in place.
這種方式既依賴感染者準確地報告他們的接觸人群，又要看衛生部門是否有能力對每一個人進行追蹤。即使在確診病例數很少的情況下，常規衛生工作者也不可能完成這一切。每一個衛生系統都要想辦法配備更多人員，以便及時完成這項工作。每一位從事此工作的人員必須接受相應的培訓，並要求其對相關信息保密。研究者會被要求通過數據庫發現感染的模式，同時需要再次強調隱私保護措施。
Opening up 重新開放
Most developed countries will be moving into the second phase of the epidemic in the next two months. In one sense, it is easy to describe this next phase. It is semi-normal. People can go out, but not as often, and not to crowded places. Picture restaurants that only seat people at every other table, and airplanes where every middle seat is empty. Schools are open, but you can’t fill a stadium with 70,000 people. People are working some and spending some of their earnings, but not as much as they were before the pandemic. In short, times are abnormal but not as abnormal as during the first phase.
大多數發達國家將會在未來兩個月內進入疫情的第二階段，從某種意義上來說，這個階段很容易描述——半正常狀態。人們可以外出，但並不像以前那樣頻繁，也不會去人多的地方。想象一下餐館中人們隔桌就餐、飛機上每排中間的座位是空出來的場景，或者學校開學但是不會出現一個體育場坐滿七萬多人的情況。人們會做一些工作，有一些消費，但不像大流行病到來之前他們所做的那樣。總之，這段時間人們的生活會受到影響，但也不像第一階段那麼不正常。
The rules about what is allowed should change gradually so that we can see if the contact level is starting to increase the number of infections. Countries will be able to learn from other countries that have strong testing systems in place to inform them when problems come up.
對活動限制的放寬應該逐漸調整，這樣我們就可以觀察，增加接觸程度是否會導致感染人數的增加。各國可以向其他擁有強大檢測體系從而能及時發現問題的國家學習。
One example of gradual reopening is Microsoft China, which has roughly 6,200 employees. So far about half are now coming in to work. They are continuing to provide support to employees who want to work at home. They insist people with symptoms stay home. They require masks and provide hand sanitizer and do more intensive cleaning. Even at work, they apply distancing rules and only allow travel for exceptional reasons. China has been conservative about opening up and has so far avoided any significant rebound.
微軟中國是逐步復工的一個例子，它有大概6200名員工。目前有大約半數的員工回到了工作崗位。公司繼續為希望在家辦公的員工提供支持，並要求有症狀的人待在家裡。公司要求員工佩戴口罩、提供洗手液，並進行更密集的清潔消毒工作。即使在工作中，也要求員工保持一定社交距離，特殊情況下才允許出差。對於復工復產，中國一直保持謹慎的態度，截至目前沒有出現明顯的疫情反彈。
The basic principle should be to allow activities that have a large benefit to the economy or human welfare but pose a small risk of infection. But as you dig into the details and look across the economy, the picture quickly gets complicated. It is not as simple as saying “you can do X, but not Y.” The modern economy is far too complex and interconnected for that.
基本原則應該是允許那些對經濟或人民福利有較大好處且感染風險較小的活動。然而，當你深入細節、審視經濟方方面面時，情況很快就會變得複雜起來。你無法簡單的說“可以做這個，但不能做那個”，因為現代經濟是非常複雜且緊密連接的。
For example, restaurants can keep diners six feet apart, but will they have a working supply chain for their ingredients? Will they be profitable with this reduced capacity? The manufacturing industry will need to change factories to keep workers farther apart. Most factories will be able to adapt to new rules without a large productivity loss. But how do the people employed in these restaurants and factories get to work? Are they taking a bus or train? What about the suppliers who provide and ship parts to the factory? And when should companies start insisting their employees show up at work?
舉例來說，餐廳可以讓食客相互保持六尺（約1.8米）的距離，但是否有供應鏈為餐廳提供相應的食材？在如此低上座率的情況下，他們是否可以盈利？製造業需要調整工廠設施，以便讓工人之間保持較遠的距離。大多數工廠能夠在沒有很大生產力損失的情況下適應新的規定。但在這些餐館和工廠的員工將如何上班？他們會搭乘公共汽車或軌道交通嗎？那些為工廠提供和運輸零件的供應商怎麼辦？企業應該從什麼時候開始要求員工回到公司上班呢？
There are no easy answers to these questions. Ultimately, leaders at the national, state, and local levels will need to make trade-offs based on the risks and benefits of opening various parts of the economy. In the United States it will be tricky if one state opens up too fast and starts to see lots of infections. Should other states try to stop people moving across state boundaries?
這些問題都沒有簡單的答案。最終，國家、州、地方各級領導人都需要根據恢復經濟不同部分的風險與收益進行權衡。在美國，如果一個州復工復產的速度過快，開始出現大量的感染，其他州是否應該阻斷人們跨州移動呢？這就可能讓問題變得棘手。
Schools offer a big benefit and should be a priority. Large sporting and entertainment events probably will not make the cut for a long time; the economic benefit of the live audience doesn’t measure up to the risk of spreading the infection. Other activities fall into a gray area, such as church services or a high school soccer game with a few dozen people on the sidelines.
復學的好處有很多，應該被優先考慮。大型體育及娛樂活動可能很長一段時間內都不會恢復正常，現場觀眾帶來的經濟收益與感染傳播的風險無法相提並論。其他活動，例如教會活動或幾十人在場邊觀看的高中足球比賽，則屬於中間地帶。
There is one other factor that is hard to account for: human nature. Some people will be naturally reluctant to go out even once the government says it is okay. Others will take the opposite view—they will assume that the government is being overly cautious and start bucking the rules. Leaders will need to think carefully about how to strike the right balance here.
還有一個很難計算的因素：人性。有些人不願意出門，即便政府說這是可以的。另外一些人則完全相反，認為政府是過度謹慎，於是開始違背規則。領導人需要認真考慮在這方面如何取得平衡。
Conclusion 結語
Melinda and I grew up learning that World War II was the defining moment of our parents’ generation. In a similar way, the COVID-19 pandemic—the first modern pandemic—will define this era. No one who lives through Pandemic I will ever forget it. And it is impossible to overstate the pain that people are feeling now and will continue to feel for years to come.
梅琳達和我從小就知道，第二次世界大戰是我們父母那一代人經歷的決定性時刻，影響了他們的一生。同樣，新冠肺炎——第一個現代大流行病——也將重新定義我們這個時代。經歷過這個“1號現代大流行病”的人永遠都不會忘記它。人們在當下正在經歷的痛苦，和那些在今後幾年裡仍將持續感受到的痛苦，怎麼描述都不為過。
The heavy cost of the pandemic for lower-paid and poor people is a special concern for Melinda and me. The disease is disproportionately hurting poorer communities and racial minorities. Likewise, the economic impact of the shutdown is hitting low-income, minority workers the hardest. Policymakers will need to make sure that, as the country opens up, the recovery doesn’t make inequality even worse than it already is.
這次大流行病給低收入者和貧困人群造成的沉重代價，是梅琳達和我特別關切的問題。這種疾病對貧困社區和少數族裔的傷害尤其大。同樣，經濟停擺對低收入群體和少數族裔的工薪階層造成的影響也是最嚴重的。決策者需要確保隨著國家的重新開放，經濟復甦不會加劇不平等現象的惡化。
At the same time, we are impressed with how the world is coming together to fight this fight. Every day, we talk to scientists at universities and small companies, CEOs of pharmaceutical companies, or heads of government to make sure that the new tools I’ve discussed become available as soon as possible. And there are so many heroes to admire right now, including the health workers on the front line. When the world eventually declares Pandemic I over, we will have all of them to thank for it.
同時，世界各國正在齊心協力打好這場戰役，這讓我們深為感佩。每一天，我們都在與科學家們、製藥企業的CEO們以及政府的領導人們進行交流，希望前面談到的那些創新解決方案能夠早日問世。每一天，都有太多的英雄人物值得敬仰，尤其是那些奮戰在一線的醫護工作者們。當世界最終宣佈1號現代大流行病結束時，我們應該對他們所有人道一聲感謝。
